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Research ArticleRegular Articles

Offenders With Substance Abuse Who Receive Mandatory Psychiatric Treatment

Pei-Chuan Wu, Yu-Ching Chou, Hui-Wen Yeh, San-Yuan Huang, Li-Hsiang Cheng, Yu-Chen Kao, Hsin-An Chang and Nian-Sheng Tzeng
Journal of the American Academy of Psychiatry and the Law Online September 2017, 45 (3) 316-324;
Pei-Chuan Wu
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
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Yu-Ching Chou
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
PhD
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Hui-Wen Yeh
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
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San-Yuan Huang
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
MD, PhD
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Li-Hsiang Cheng
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
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Yu-Chen Kao
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
MD, MSc
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Hsin-An Chang
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
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Nian-Sheng Tzeng
Dr. Wu is Attending Psychiatrist, Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan. Dr. Huang is Attending Psychiatrist and Professor; Dr. Cheng is Attending Physician, Department of Otolaryngology-Head and Neck Surgery; Dr. Chang is Attending Psychiatrist and Assistant Professor; and Dr. Tzeng is Attending Psychiatrist, Assistant Professor and the Director of Program for Forensic Psychiatry Training, Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan. Dr. Chou is Associate Professor, School of Public Health, National Defense Medical Center, Taipei, Taiwan. Ms. Yeh is a lecturer, Department of Nursing, Kang-Ning College of Healthcare and Management, Kang-Ning University, Taipei, Taiwan. Dr. Kao is the Director and Assistant Professor, Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan.
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    Figure 1.

    Offenders Receiving Forensic Psychiatry Evaluations (June 30, 2002 - July 1, 2010).

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    Table 1

    Before the Penal Code Revision of 2006

    VariableActual Mandatory Treatment Received, n (%)χ2 (df)p
    Yes (n = 41)No (n = 149)
    Reason for referral1.025 (2)0.599*
        Recidivism8 (19.5)36 (24.2)
        Court's investigation21 (51.2)80 (53.7)
        Medical history12 (29.3)33 (22.1)
    Result or type of crime9.041 (5)0.102†
        Death3 (7.3)25 (16.8)
        Injury11 (26.8)22 (14.8)
        Property damage13 (31.7)61 (40.9)
        Public disorder11 (26.8)24 (16.1)
        Drug crime1 (2.4)12 (8.1)
        Other2 (4.9)5 (3.4)
    Gender0.407 (1)0.587†
        Male41 (100.0)144 (96.6)
        Female0 (0)5 (3.4)
    Diagnosis13.673 (4)0.006†
        Dependence2 (4.9)17 (11.4)
        Abuse4 (9.8)12 (8.1)
        Substance-induced psychotic disorder23 (56.1)45 (30.2)
        Substance-induced mood disorder9 (22.0)32 (21.5)
        Intoxication3 (7.3)43 (28.9)
    Substance7.442 (6)0.364†
        Alcohol19 (46.3)69 (46.3)
        Amphetamine5 (12.2)29 (19.5)
        Heroin0 (0)3 (2.0)
        Glue6 (14.6)7 (4.7)
        Other4 (9.8)11 (7.4)
        Any two6 (14.6)21 (14.1)
        More than three1 (2.4)9 (6.0)
    Area4.463 (2)0.107*
        Urban7 (17.1)51 (34.2)
        Suburban14 (34.1)40 (26.8)
        Rural20 (48.8)58 (38.9)
    Judges' acceptance of forensic psychiatrists' opinions on legal responsibility28.171 (3)<0.001†
        Both not responsible6 (14.6)2 (1.3)
        Both diminished responsibility28 (68.3)67 (45.0)
        Both fully responsible4 (9.8)69 (46.3)
        Discordant3 (7.3)11 (7.4)
    • n = 190. df, degree of freedom.

    • ↵* Chi-square.

    • ↵† Fisher's exact test.

    • View popup
    Table 2

    After the Penal Code Revision of 2006

    VariableActual Mandatory Treatment Received, n (%)χ2 (df)p
    Yes (n = 46)No (n = 176)
    Reason for referral16.814 (2)<0.001*
        Recidivism19 (41.3)30 (17.0)
        Court investigation12 (26.1)99 (56.3)
        Medical history15 (32.6)47 (26.7)
    Result or type of crime7.576 (5)0.167†
        Death1 (2.2)20 (11.4)
        Injury9 (19.6)47 (26.7)
        Property damage21 (45.7)67 (38.1)
        Public disorder9 (19.6)21 (11.9)
        Drug crime5 (10.9)12 (6.8)
        Other1 (2.2)9 (5.1)
    Gender0.811 (1)0.349†
        Male46 (100.0)169 (96.0)
        Female0 (0)7 (4.0)
    Diagnosis26.549 (4)<0.001†
        Dependence4 (8.7)39 (22.2)
        Abuse4 (8.7)19 (10.8)
        Substance-induced psychotic disorder24 (52.2)31 (17.6)
        Substance-induced mood disorder9 (19.6)33 (18.8)
        Intoxication5 (10.9)54 (30.7)
    Substance15.832 (6)0.026†
        Alcohol21 (45.7)103 (58.5)
        Amphetamine7 (15.2)27 (15.3)
        Heroin0 (0)8 (4.5)
        Glue4 (8.7)4 (2.3)
        Other substance5 (10.9)15 (8.5)
        Any two7 (15.2)19 (10.8)
        More than three2 (4.3)0 (0)
    Area6.922 (2)0.031*
        Urban12 (26.1)70 (39.8)
        Suburban8 (17.4)44 (25.0)
        Rural26 (56.5)62 (35.2)
    Judges' acceptance of the forensic psychiatrists' opinions on legal responsibility69.125 (3)<0.001†
        Both not responsible1 (2.2)1 (0.6)
        Both diminished responsibility38 (82.6)34 (19.3)
        Both fully responsible6 (13.0)122 (69.3)
        Discordant1 (2.2)19 (10.8)
    • n = 222. df, degree of freedom.

    • ↵* Chi-square.

    • ↵† Fisher's exact test.

    • View popup
    Table 3

    Logistic Regression Analysis of Risk Factors for Mandatory Treatment

    ORUnivariate (95% CI)pORMultivariate* (95% CI)p
    Reasons for referral
        Recidivism1.21(0.65–2.26)0.5461.13(0.53–2.40)0.760
        Court investigation0.55(0.31–0.97)0.039*0.60(0.30–1.24)0.168
        Medical history1.00(reference)1.00(reference)
    Substance use disorder and related mental illness
        Dependence1.30(0.43–3.94)0.6441.43(0.42–4.84)0.567
        Abuse3.13(1.08–9.03)0.035*3.30(1.00–10.90)0.051
        Substance-induced psychotic disorder7.50(3.34–16.81)<0.001*4.77(1.77–12.87)0.002*
        Substance-induced mood disorder3.36(1.38–8.18)0.008*2.29(0.82–6.43)0.114
        Intoxication1.00(reference)1.00(reference)
    Substance
        Alcohol0.70(0.18–2.69)0.6020.85(0.17–4.23)0.842
        Amphetamine0.64(0.15–2.73)0.5500.35(0.06–1.94)0.230
        Heroin––0.999––0.999
        Glue2.73(0.57–13.01)0.2081.07(0.17–6.84)0.941
        Other1.04(0.23–4.70)0.9610.83(0.14–5.06)0.841
        Any two0.97(0.23–4.15)0.9730.84(0.15–4.68)0.839
        More than three1.00(reference)1.00(reference)
    Court location
        Urban0.41(0.23–0.74)0.003*0.40(0.19–0.81)0.011*
        Suburban0.68(0.38–1.22)0.1980.62(0.31–1.26)0.187
        Rural1.00(reference)1.00(reference)
    Judges' acceptance of the forensic psychiatrists' opinions on legal responsibility
        Both not responsible17.50(3.17–96.58)0.001*16.39(2.72–98.81)0.003*
        Both diminished responsibility4.90(1.65–14.55)0.004*3.14(0.99–10.01)0.058
        Both fully responsible0.39(0.12–1.33)0.1340.38(0.11–1.37)0.093
        Discordant1.00(reference)1.00(reference)
    • The ORs were calculated after mutual adjustment for the variables shown. OR, odds ratio; CI, confidence interval.

    • ↵* p < 0.05.

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Journal of the American Academy of Psychiatry and the Law Online: 45 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 45, Issue 3
1 Sep 2017
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Offenders With Substance Abuse Who Receive Mandatory Psychiatric Treatment
Pei-Chuan Wu, Yu-Ching Chou, Hui-Wen Yeh, San-Yuan Huang, Li-Hsiang Cheng, Yu-Chen Kao, Hsin-An Chang, Nian-Sheng Tzeng
Journal of the American Academy of Psychiatry and the Law Online Sep 2017, 45 (3) 316-324;

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Offenders With Substance Abuse Who Receive Mandatory Psychiatric Treatment
Pei-Chuan Wu, Yu-Ching Chou, Hui-Wen Yeh, San-Yuan Huang, Li-Hsiang Cheng, Yu-Chen Kao, Hsin-An Chang, Nian-Sheng Tzeng
Journal of the American Academy of Psychiatry and the Law Online Sep 2017, 45 (3) 316-324;
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